The Rise of Specialty Pharmacy Costs: Issues for Providers, Payers, and Patients
Steve B. Miller
Tracy A. Hoffman
Jonah C. Houts
Jane L. Miller
Britton L. Pim
The growth of specialty medication costs is having a visible impact on the market. These drugs - the products of groundbreaking scientific and technological advances in medicine - offer tremendous promise for the treatment of serious debilitating and life-threatening illnesses; however, the average treatment cost per patient for these medicines is about $US18_000 per prescription per year and their use is rapidly growing. This article reviews the unique characteristics of specialty drugs, their profound medical potential, as well as how their cost, complexity, and reimbursement structure are producing unique issues for physicians, plans, and patients. Misaligned interests and incentives are identified as challenges that can affect the dynamic between these constituents whose working relationships are critical to the health system. Resulting mismanagement of specialty drugs could lead to higher costs and reduced outcomes. While society stands to benefit significantly from specialty drugs, investment is needed in programs that align interests and enhance coordination between physicians, payers, and patients. Such programs will drive clinically appropriate, cost-effective use of these medications to ensure the greatest benefit. Among these proposed programs are the development of care guidelines that are customized to patients prescribed specialty medications, the implementation of cost-management programs, timely patient support and education, and the development of effective utilization management programs that clearly define the intent of specialty drug use.
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